Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis.
Brehaut E., Neupane D., Levis B., Wu Y., Sun Y., Krishnan A., He C., Bhandari PM., Negeri Z., Riehm KE., Rice DB., Azar M., Yan XW., Imran M., Chiovitti MJ., Saadat N., Cuijpers P., Ioannidis JPA., Markham S., Patten SB., Ziegelstein RC., Henry M., Ismail Z., Loiselle CG., Mitchell ND., Tonelli M., Boruff JT., Kloda LA., Beraldi A., Braeken APBM., Carter G., Clover K., Conroy RM., Cukor D., da Rocha E Silva CE., De Souza J., Downing MG., Feinstein A., Ferentinos PP., Fischer FH., Flint AJ., Fujimori M., Gallagher P., Goebel S., Jetté N., Julião M., Keller M., Kjærgaard M., Love AW., Löwe B., Martin-Santos R., Michopoulos I., Navines R., O'Rourke SJ., Öztürk A., Pintor L., Ponsford JL., Rooney AG., Sánchez-González R., Schwarzbold ML., Sharpe M., Simard S., Singer S., Stone J., Tung K-Y., Turner A., Walker J., Walterfang M., White J., Benedetti A., Thombs BD.
OBJECTIVES: Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence. METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated. RESULTS: 6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%. CONCLUSIONS: HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.